Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

There’s a situation referred to as as ‘Janu Vishlesha’ talked about amongst Vata Nanatmaja Rogas – particular and particular problems brought on by aggravation of ‘solely vata’. Completely there are eighty nanatmaja rogas of vata. Janu Vishlesha is one amongst them.

Phrase Which means

The phrase Janu Vishlesha is made up of two phrases – Janu and Vishlesha

Janu = Knee joint

Vishlesha means feeling of looseness, which additionally means instability. Different meanings of the time period vishlesha are –

–         Separation, separate from
–         Falling asunder / aside
–         Dissolution – Destruction by breaking down
–         Disjunction – lack of consistency
–         Trigger to be disunited

Causes for Janu Vishlesha

1. Abhyantara Nidana: Intrinsic Causes

Kapha issue: Sandhi Bandha – binding the joints and protecting them built-in is without doubt one of the chief capabilities of balanced kapha. Kapha lubricates the bony joints and retains them moist and versatile. That is caused by the unctuous, secure and easy qualities of kapha. The actions are straightforward on the joints as a result of presence of shleshaka kapha – subtype of kapha, in balanced proportions. The joints give means and turn out to be free when this kapha decreases. Kapha depleting meals and actions will hit exhausting on the integrity of joints. However, kapha depletion will result in a rise of vata. This may additional injury the joints by depleting the lubricating substances that are pure to these joints and convey about instability therein. When these occasions occur in knee joints, it could result in janu vishlesha.

Vata issue: Vata, in its balanced and serene state is answerable for correct actions on the joints and locomotion. When vata will get aggravated within the joints it destroys kapha – the protecting buffer, moistness and lubrication of these joints, as a consequence of its dry and tough qualities. The causes embody vata aggravating meals and actions. Sandhi vishlesha is brought on by vata aggravation within the knee joints.

Observe: Vata and kapha are antagonistic doshas. Improve of 1 dosha would lower the opposite. The opposite means can also be true. So, vata rising meals and actions by default would deplete kapha. Equally, kapha depleting meals and actions would improve vata.

Pathogenesis of Janu Vishlesha, Kapha Kshaya and Vata Vriddhi hyperlink

Integrity and lubrication of any joint together with Janu Sandhi – knee joint is caused by balanced kapha positioned within the joints, primarily shleshaka kapha – joint particular subtype of kapha. The actions and suppleness and involvement of joints in locomotion is caused by balanced vata. So long as the connection of kapha and vata concerned in joint integrity and functioning is balanced, the joints are secure and wholesome. When there’s a proportional imbalance of those two doshas, particularly kapha lower adopted by vata improve or vice versa, there happens laxity or feeling of looseness within the joints and a really feel of ‘joints giving means’. That is referred to as ‘Janu Vishlesha’.

Medo Upadhatu issue

Snayu – ligaments (and tendons) and Sandhi (joints) are the upadhatus – sub-tissues of medo dhatu (fats tissue). Each these parts are affected by knee instability. So, one ought to hold a examine on the physique weight. Being chubby or overweight could also be a threat issue and will trigger extreme stress on the ligaments across the knee joint and the joint itself in order to trigger instability and painful situations of knee joint.

2. Bahya Nidana – Exterior Causes

Damage issue – vata and rakta aggravation

Tears and harm to the ligaments in and across the knee joint is the primary trigger for janu vishlesha vis-à-vis instability of the knee. Damage is an extrinsic issue which later results in aggravation of vata. Damage additionally causes aggravation of rakta.

Ati Vyayama – as nidana

Ati Vyayama – extreme workout routines and bodily actions past one’s capability is the chief reason for trauma, compression and vata aggravation within the knee joint which can in flip result in janu vishlesha.

3. Bahya-Abhyantara Nidana – Exterior and Inner Causes

Majjavaha Srotas issue

Asthi – bones and Sandhi – joints are the roots of the majjavaha srotas – channels transporting / or answerable for formation and upkeep of bone marrow. Utpesha – crushing accidents, abhighata – accident, trauma and prapeedana – compression are the essential causes for contamination of majjavaha srotas. These are additionally the chief causative elements for knee instability. Viruddha Ahara – consumption in extra of mutually incompatible meals and Ati Abhishyandana – being stuffed with moist parts / kapha are the intrinsic causes for contamination of majjavaha srotaas. A mixture of each these elements concerned within the pathogenesis occurring within the bones and joints involving the knee joint could trigger ache and instability associated to janu vishlesha vis-à-vis knee joint / joints.

Within the illness vatarakta, vata and rakta are individually aggravated as a consequence of their particular person aggravating elements. Within the later a part of pathogenesis, vata and rakta mutually afflict one another and trigger the illness vatarakta. This situation is brought on by a combination of intrinsic and extrinsic elements as defined within the nidana of the illness. Damage is the frequent extrinsic issue for aggravation of each vata and rakta. When harm is the frequent issue aggravating vata and rakta together with their particular person aggravating elements, they could come into the way in which of one another and trigger a situation referred to as vatarakta. This situation could cause painful situations of the joints. When this pathogenesis happens within the knee joint / joints, it could trigger joint instability together with ache and different signs of vatarakta. On this situation, knee joint won’t be the one joint stricken.

Sandhi Vikriti: Joint illnesses and deformities

Many joint problems, primarily these that are power, would trigger janu vishlesha – knee instability in the long term. They embody –

Janu Sandhigata Vata – popularly in comparison with osteoarthritis, additionally impacts the knee joints and is without doubt one of the problems which could trigger knee instability i.e. janu vishlesha in the long term. This can be a vata dysfunction whereby aggravated vata localized within the knee joint causes sandhi nasha – destruction of the joint together with the destruction of ligaments, tendons, sinews and the complete joint inflicting janu vishlesha. Shula – ache and Atopa – sounds / swelling within the joint are the opposite signs. There’s additionally problem in actions on the knee joint, primarily prasarana – extension and akunchana – flexion of the knee joint.

Amavata – typically correlated with rheumatoid arthritis, is a illness brought on by a vicious mixture of ama and vata. It’s a systemic illness which begins from the intestine and ends by affecting the musculoskeletal system. Among the many a number of joints it impacts, the knee joint can also be the one. Other than ache and swelling of the joint, it could additionally trigger janu vishlesha.

Vatarakta – typically correlated with gouty arthritis, can also be a systemic dysfunction which sooner or later of time afflicts the joints. The pathogenesis of vatarakta has been defined above. It is without doubt one of the causes for Janu Vishlesha.

Although ‘janu vishlesha’ has not been instantly talked about among the many signs of any of those situations, the situation occurring within the course of of those illnesses will be inferred via their pathogenesis and in addition from the attitude that vata is concerned in all these illnesses and all of them do have an effect on the knee joint.

Fashionable Perspective of Janu Vishlesha

Indicators and signs of knee instability v/s Janu Vishlesha

Instability of the knee joint is the primary symptom of ‘knee instability’. Janu Vishlesha too means the identical.

Indicators and signs of ‘knee instability’ are relatable to the signs of vata aggravation.

Popping sound, sudden and extreme ache, swelling, incapability to bear weight and sensation of joint looseness or instability – that are the indicators and signs of ‘knee instability’, that are additionally the indicators and signs of ‘vata aggravation’. All these signs are additionally half and parcel of janu vishlesha.

The identical are additionally the signs of ‘sandhigata vata’.

‘Janu Vishlesha’ will be correlated with a situation referred to as ‘Knee Instability’ defined in trendy medication. The signs of knee instability which comply with harm are brought on by aggravated vata.

Therapy Rules of Janu Vishlesha

Nidana Parivarjana – Since Janu Vishlesha is principally brought on by vata aggravation, all etiological elements resulting in it shall be saved away. Primarily, one must be cautious about their nature of labor particularly whether it is ‘harm inclined’ work and in addition extreme and vigorous bodily actions, together with sporting. Any harm or insult taking place to the knee joint must be instantly addressed with appropriate interventions.

Vata and Kapha balancing – The important thing to deal with Janu Vishlesha will probably be to convey vata and / or kapha to a state of stability and in addition to result in their relative stability.

Since vata is the chief dosha concerned within the causation of this situation and can also be a vata nanatmaja roga, the medicines, therapies and dietetic protocols meant to deal with vata rogas are additionally relevant right here.

Coping with Medo Vriddhi – Fats improve, weight problems or being chubby would impart excessive stress on the knee joint because it is a crucial weight bearing joint and trigger injury to the joint, and associated buildings i.e. muscle mass, bones, ligaments, tendons and blood vessels get injured and consequently broken. Weight administration is the important thing technique on this situation.

Coping with sandhi vikriti

Illnesses like vatarakta, sandhigata vata or amavata afflicting the knee joint shall be successfully dealt with with appropriate interventions. This may examine the additional injury to the joint. Additional the knee joint could also be strengthened by balya and brimhana remedies and medicines.

Coping with asthivha and majjavaha sroto dushti and gata vata

Contamination or injury to channels associated to asthi – bones and majja – bone marrow could cause janu vishlesha. Equally, it could even be brought on by situations like asthigata vata or majjagata vata – aggravated vata localized in bones or bone marrow respectively and shall be dealt accordingly.

Balya, Brimhana and Rasayana Chikitsa

To strengthen the knee joint and to reinforce stability therein, balya – strengthening, brimhana – bulk selling and rasayana – anti-ageing / rejuvenation medicines and meals must be administered.

1. Bahya Chikitsa – Exterior therapies

Under talked about exterior remedies will probably be useful in strengthening the knee joint and in addition in decreasing the signs of sandhi vishlesha and in addition would stability the vitiated vata.

–         Abhyanga – therapeutic massage with natural / vata mitigating oils
–         Swedana – sudation – patra pinda sweda, shashtika shali pinda sweda
–         Swedana – sudation – patra pinda sweda, shashtika shali pinda sweda
–         Janu Vasti – oil pooling across the stricken knee joint / joints

2. Abhyantara Chikitsa – Inner medicines

The interior interventions for janu vishlesha are as beneath talked about –

–         Sneha pana / Snehana – oral consumption of medicated fat, primarily ghee or ghee and oil – like Guggulutiktaka Ghrta, Ashwagandha Ghrta and so forth.
–         Vasti – enema with medicated ghee / oil or each – utilizing the identical medicines talked about in Sneha pana

Helpful formulations

–         Maharasnadi Kashayam
–         Sahacharadi Kashayam
–         Dhanwantaram Kashayam
–         Rasnasaptaka Kashayam
–         Guggulutiktakam Ghrtam
–         Ksheerabala Taila
–         Yogaraja Guggulu

Helpful Yoga Postures

–         Utkatasana – Chair pose
–         Virabhadrasana II – Warrior II Pose
–         Ardhachandrasana – Half moon pose
–         Utkata Konasana – Goddess Pose
–         Prapadasana – Tip Toe Pose
–         Ardha Purvottanasana – Reverse Desk High
–         Balasana – Baby’s Pose
–         Dandasana – Workers / Stiff Pose
–         Sethu Bandhasana – Bridge Pose
–         Janu Shirsasanan – Head to knee ahead bend
–         Utthitha Parsvakonasanan – Prolonged aspect angle
–         Malasana – Garland Pose
–         Paschimottanasana – Seated Ahead Bend

Fashionable Correlation

Janu Vishlesha will be correlated with a situation defined in trendy medication named ‘Instability of Knee Joint’, by which means and in addition by comparable medical presentation.

Knee instability is generally brought on by accidents or problems affecting the ligaments throughout the knee joint. It presents as a sensation of ‘giving out’ or ‘buckling’ of the knee joint, primarily when the joint is subjected to stress. It occurs when the ligaments across the knee joint fail to carry the bones making the knee joint in place securely. This ultimately ends in a wobbly feeling whereas bearing weight on the knees. Tears of ACL, MCL and PCL majorly contribute to the knee instability. Other than tears and accidents, it could even be brought on by varied actions associated to life-style – like twisting, leaping or sudden stops and so forth. Knee osteoarthritis, patellar instability, knee strains and sprains, gout, an infection of knee joint, meniscus tear or bursitis might also trigger knee instability.

The chief signs of knee instability embody loud popping or snapping sounds within the joint, sudden and extreme ache manifestation, feeling of looseness of the knee joint, incapability to bear the load on the affected joint and swelling.

Associated Studying – Knee Instability